Studies Examine Effect Of Male Circumcision On Sexual Behavior, Breast-Feeding Interventions For HIV-Positive Women

The following highlights recently released journal articles on HIV/AIDS.

Male Circumcision in Siaya and Bondo Districts, Kenya: Prospective Cohort Study To Assess Behavioral Disinhibition Following Circumcision," Journal of Acquired Immune Deficiency Syndromes: Kawango Agot -- project coordinator of a collaborative research project among the University of Nairobi, University of Illinois and the University of Manitoba -- and colleagues conducted the study among 324 recently circumcised men and 324 uncircumcised men to determine the effect of circumcision on sexual behavior. The researchers compared the two groups' sexual behaviors at one, three, six, nine and 12 months following circumcision or study enrollment. They found that during the first month following circumcision, men were 63% less likely to report having 0 to 0.5 risky sexual acts weekly than uncircumcised men. The researchers also found that during the first month following circumcision, men were 61% less likely to report having more than 0.5 risky sexual acts weekly than uncircumcised men. The differences in sexual behavior disappeared during the remainder of the follow-up period, and similar results were seen for risky unprotected sexual acts, number of at-risk sexual partners and condom use, according to the researchers. The researchers concluded that during the first year following circumcision, men did not report an increased number of risky sexual acts compared with uncircumcised men -- indicating that "any protective effect of male circumcision on HIV acquisition is unlikely to be offset by an adverse behavioral impact" (Kawango et al., Journal of Acquired Immune Deficiency Syndromes, 1/1).

Two-Year Morbidity-Mortality and Alternatives to Prolonged Breast-Feeding Among Children Born to HIV-Infected Mothers in Cote d'Ivoire," PLoS Medicine: Renaud Becquet of the Institut National de la Sante et de la Recherche Medicale Unite in France and colleagues conducted the study from 2001 through 2005 among 557 infants born to HIV-positive women in Abidjan, Cote d'Ivoire. After their infants were born, the women, who underwent prenatal antiretroviral prophylaxis, either received breastmilk substitutes or exclusively breast-fed for four months. Nutritional counseling and clinical management were provided for two years, and breastmilk substitutes were provided at no cost. Thirty-four percent of the 262 infants who were breast-fed for an average of four months during the two-year follow-up period did not experience any adverse health outcomes -- which the researchers defined as diarrhea, acute respiratory infections or malnutrition -- compared with 37% of the infants who received breastmilk substitutes. The two-year probability of presenting with a severe health event -- which the researchers defined as hospitalization or death -- was 14% among the breastmilk substitute group, compared with 15% among the breast-fed infants. The researchers concluded that breastmilk substitutes and short-term breast-feeding can be safe interventions aimed at preventing mother-to-child HIV transmission in urban African settings where adequate nutritional counseling and care, access to clean water and breastmilk substitutes are available (Becquet et al., PLoS Medicine, January 2007). In a related opinion piece, Grace John-Stewart of the University of Washington writes that the researchers "provide good data to suggest that with appropriate provisos, replacement feeding can be a safe option to consider" for HIV-positive women in urban African settings (John-Stewart, PLoS Medicine, January 2007).

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Engineered Immune Cells And AIDS

Twenty years after its introduction, gene therapy still holds great promise as a way to harness the insidious power of viruses such as human immunodeficiency syndrome (HIV). But scientists have yet to solve a vexing problem: developing an efficient transport system that is capable of delivering therapeutic payloads to specific cells.

As challenging as the problem has been, researchers in the USC Viterbi School of Engineering may be turning a corner. With support from a $13.9 million grant from the Bill and Melinda Gates Foundation, a multi-institutional team of scientists, including Pin Wang of the USC Mork Family Department of Chemical Engineering and Materials Science, is exploring a completely new way of manipulating the body's natural defense system.

"Rather than focusing on conventional vaccines that boost the immune system, we are experimenting with a way to help the immune system produce antibodies that can neutralize the virus," says Wang. "If we can design a modified virus that will deliver these antibodies to chosen cells, we will be able to insert DNA that will help rather than harm cells."

Viruses are efficient carriers or transport vehicles in the body because they are naturally able to penetrate cells, inserting the genetic material they contain into their new host. By itself, a virus cannot reproduce; it must infect a cell and take control of the host's machinery to make copies.

HIV also possesses an unusual structure and a keen ability to hide from antibodies in a sugar-coated shield. The shield has very few open spaces on its surface, Wang says, which makes it virtually impossible to penetrate. And because the virus also has an uncanny ability to hide, HIV often goes virtually unnoticed by neutralizing antibodies that are roaming the body in search of foreign invaders.

Faced with such a clever adversary, Wang wants to synthetically alter the HIV invaders and use their hollow shells as delivery vehicles to insert DNA that will counteract the infection.

The "Cadillac" of this gene delivery system is an HIV-based "lentiviral vector," a type of retrovirus that uses the backbone of a virus to infect both dividing and nondividing cells. Wang says lentiviral vectors are very efficient delivery vehicles for human cells.

Collaborators on his project are targeting hematopoietic stem cells -- the bone marrow cells that form blood cells - to create B lymphocytes. The researchers want to reprogram these bone marrow cells by adding genes that will instruct the cells to produce rare antibodies such as B12, 4E10, 2G12 and 2F5. Wang says these antibodies are known to neutralize the virus.

"In laboratory tests, we remove harmful genes coding for the HIV virus and engineer the backbone, or spine, of virus so that it is no longer replicable " he says. "Once manufactured recombinantly, this modified virus - the lentiviral vector -- becomes a natural delivery system that can transport useful genes into cells without causing illness."

Although the gene delivery technique looks promising, researchers are still working on ways to manipulate these elusive bone marrow cells and get them to generate "designer immune cells." Another problem seems to be making sure lentiviral vectors target only hematopoietic stem cells, and not other types of cells, to achieve the desired targeted delivery.

With a group of USC biomedical engineering students and Caltech biologists, Wang is experimenting with CD20 as a target antigen for human B cells. His strategy, published in the August 1, 2006 issue of Proceedings of the National Academy of Sciences, targets the human B cells only. After two years of experimentation, the team has been able to demonstrate that they can specifically target human B cells in mice.

"Possibly the most important implication of the work is that gene therapy could now be carried out as an inexpensive procedure, able to be considered even in the less-developed world," Wang and his coauthors wrote.

That's good news for the World Aids Foundation, which announced on World AIDS Day (Dec. 1, 2006) that the disease is on the rise again. More than 39 million people around the world are now infected with HIV, the foundation reported.

"I think we are finally on the right track," Wang says. "If scientists can find a way to genetically engineer immune cells to neutralize HIV, we may be able to develop immunotherapy for HIV-Infected people, as well as find ways to prevent it all together."

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Wang's research is part of the Gates Foundation's Grand Challenges in Global Health initiative, which was launched in 2003 to create "deliverable health tools" that were "not only effective, but also inexpensive to produce, easy to distribute and simple to use in developing countries."

Collaborators on the five-year project, titled "Engineering Immunity Against HIV and Other Dangerous Pathogens," include principal investigator David Baltimore of Caltech, co-principal investigators Pamela Bjorkman of Caltech and Wang of USC. The USC student researchers working on the project are Leslie Bailey, Taehoon Cho, Haiguang Yang and Alex Lei. All four are third-year Viterbi School graduate students majoring in chemical engineering.

Contact: Diane Ainsworth
University of Southern California

China Considering Evidence That Male Circumcision Could Reduce Risk Of HIV Infection, Unlikely To Launch Campaign, Health Official Says

China is considering evidence that routine male circumcision could reduce a man's risk of HIV infection but likely will not implement such a campaign nationwide, Ru Xiaomei, deputy director general of China's National Population and Family Planning Commission, said on Friday, Reuters U.K. reports (Blanchard, Reuters U.K., 1/19). Data from two studies conducted in Kenya and Uganda released last month by NIH indicate that routine male circumcision could reduce a man's HIV infection risk through heterosexual sex by about 50%. According to researchers, male circumcision eliminates the cells most vulnerable to HIV. In addition, a circumcised penis develops thicker skin that is resistant to HIV infection. The results of the Uganda and Kenya studies were similar to the results of a study conducted in South Africa in 2005 (Kaiser Daily HIV/AIDS Report, 12/14/06).

Comments
According to Ru, Chinese officials have seen the results of the studies conducted in Africa, but the "AIDS situation in China has not yet reached such a large scale (as in Africa)." She added, "I'm not yet totally certain about the evidence for circumcision. We should exercise caution." According to Reuters U.K., the number of circumcisions performed in China is low compared with some Asian countries, including South Korea, Japan and Indonesia. In addition, a wide-scale male circumcision campaign might encounter resistance from China's non-Muslim majority, according to Ru. She added that the cost of such a campaign might present an issue because of China's 1.3 billion population. "It would be a big deal," she said, adding, "It's much more reasonable to get people to use condoms" (Reuters U.K., 1/19). <

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

International Response To Fight HIV/AIDS Among Children 'Tragically Insufficient' But 'Beginning To Change,' U.N. Report Says

The world's response to fighting HIV/AIDS among vulnerable children remains "tragically insufficient," but some countries are making progress in providing treatment for HIV-positive children and preventing transmission of the virus, according to a report released Tuesday by UNAIDS, UNICEF and the World Health Organization, the New York Times reports (Altman, New York Times, 1/17). The report, released on the first anniversary of the "Unite for Children, Unite Against AIDS" program, found 15.2 million children under age 18 have lost one or both parents to AIDS-related complications (AFP/Yahoo! News, 1/16). The campaign -- which is a partnership between UNICEF, UNAIDS, and other organizations and agencies -- aims to reduce the incidence of mother-to-child HIV transmission, curb the spread of the virus among young people, and provide protection as well as emotional and financial support to children who have lost parents to AIDS-related illnesses (Kaiser Daily HIV/AIDS Report, 11/10/05). The report says that 2.3 million children younger than age 15 were living with HIV in 2005 and that 10% of the 780,000 children in need of antiretroviral drugs had access to them during the same time period. About one-third of HIV-positive infants who do not have access to treatment die from AIDS-related complications in their first year, and half of them die from AIDS-related complications by age two, the report found. These statistics indicate that about 380,000 children died from AIDS-related illnesses last year, according to UNICEF. The report identifies seven countries -- Botswana, Cape Verde, the Dominican Republic, Jamaica, Namibia, Rwanda and Thailand -- that provided antiretrovirals to at least 20% of children in need of the drugs. The lack of access to prevention and treatment interventions has left about 15.2 million children orphaned, and the number is expected to increase to 20 million by 2010, according to the report. About 9% of HIV-positive pregnant women living in low- and middle-income countries in 2005 received antiretrovirals that could prevent MTC HIV transmission, up from 3% in 2003, the report found. About 10% of pregnant women living in sub-Saharan African capital cities are HIV-positive, according to the report. The majority of pregnant women in Africa do not have access to drugs aimed at preventing MTC HIV transmission, meaning that about one-third of their infants will become HIV-positive at or shortly after birth, according to UNICEF (New York Times, 1/17). The report also found that the most successful results occurred in countries that instituted a decentralized approach to HIV/AIDS service and training, demonstrated a political commitment to fighting the disease, and incorporated prevention and treatment to entire families (Leopold, Reuters, 1/16).

Recommendations
"Over the past year, there has been a broad, growing recognition of the need to intensify and accelerate action towards universal access to comprehensive prevention, treatment, care and support" for HIV/AIDS, the report says. It calls on governments to provide at least 10% of their HIV/AIDS funding for children and adolescents. According to the report, about $30 billion is required to address the prevention strategy set out by the Unite for Children campaign, which aims to provide services to 80% of HIV-positive mothers by 2010, provide antiretroviral or antibiotic treatment to 80% of children who need it, and reduce the number of HIV-positive young people by 25% within three years (AFP/Yahoo! News, 1/16).

The report is available online. Note: Adobe Acrobat is needed to view the report.

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

HIV/AIDS PSA Campaign 'Drawing Attention' Because Of Celebrities Involved, Messages, New York Times Reports

A "provocative" HIV/AIDS public service campaign airing on several media outlets is "drawing attention" nationwide because of the celebrities featured in the announcements and the "frank nature" of their messages, the New York Times reports. The campaign -- called "Look, listen, love, respect" -- has enlisted actresses Whoopi Goldberg, Amanda Peet, Rosie Perez and Susan Sarandon to deliver "candid, no-nonsense" messages linking drug use and risky sexual behavior with the spread of HIV among men who have sex with men, according to the Times. The Internet is a central focus of the campaign, which has launched a Web site, loveandrespect.us. Video clips of the commercials also can be viewed on YouTube and MySpace. The campaign is scheduled to air on two national cable television networks, Here! and Logo, as well as on local cable TV stations owned by companies such as Cablevision, Cox Communications and Time Warner. In addition, there are plans to air the announcements in clubs and bars in cities nationwide and to produce audio versions of the spots for the national Out Q channel of Sirius Satellite Radio, the Times reports. The campaign is a collaboration between the New York City-based organizations HIV Forum NYC and the Callen-Lorde Community Health Center. It is receiving financial backing from Broadway Cares/Equity Fights AIDS and Cable Positive, the Times reports. Dan Carlson, co-founder of HIV Forum NYC, developed the campaign with Jay Laudato, executive director of Callen-Lorde, and Colin Weil, a writer, director and producer. According to Carlson, the campaign features female actors because they "felt these honest, direct, loving messages would be heard best if told by women we can see as our mothers, best friends, sisters." He added, "They can tell us things we may not be ready to hear from each other" (Elliott, New York Times, 1/16).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

WHO's Plan To Monitor HIV Drug Resistance In Botswana Likely To Fail

A World Health Organization (WHO) plan to track transmitted resistance to HIV drugs in Botswana could fail because the threshold the organization has set is too high, according to new UCLA research.

The authors of the study, which will be published Jan. 17 in the peer-reviewed online journal PLoS ONE (), based their research on the WHO's Botswana antiretroviral program, which began in 2002 and now treats some 42,000 patients. The program's goal is to treat 85,000 patients by 2009, roughly 30 percent of all those infected in Botswana.

As greater numbers are treated, the likelihood that a small percentage of patients will develop strains of HIV that are resistant to antiretroviral drugs increases. These patients may then transmit the drug-resistant strains to others, but the rates at which this may happen are unclear. The WHO surveillance system is intended to detect transmitted resistance exceeding a 5 percent threshold by 2009, though officials with the organization have not determined at what point this threshold might be reached, if at all.

According to the UCLA study, the WHO's detection test is based on a sophisticated statistical method, but the 5 percent detection threshold is an arbitrary one. Study co-author Sally Blower, UCLA professor of psychiatry and biobehavioral sciences and a member of the UCLA AIDS Institute, said the WHO threshold was primarily based on guesswork.

"They did not make any mathematical predictions on how long it would take to get to their threshold," Blower said. "Essentially, they've guessed what would happen. They should have done things on a more quantitative basis."

Blower and co-author Raffaele Vardavas, a postdoctoral fellow in Blower's research group, developed a mathematical model that traces the random evolution of drug-resistant strains of HIV in Botswana through 2009. They found that drug resistance would indeed emerge but likely at a much slower rate than the WHO anticipates, and the organization would not be able to detect it.

Though easy to implement, the WHO's statistical test would detect transmitted resistance only after it has reached 5 percent, and that threshold would likely not be reached by 2009 unless the drug-resistant strains of the virus are extremely transmissible, the authors said.

The authors note that while the WHO's monitoring plan requires a small sample size and is relatively inexpensive, it may not be entirely cost-effective at the early stages of the treatment program due to the high threshhold. Instead, they suggest that checking for transmitted resistance early this year and dropping the threshold to about 3 percent would present a better picture of the situation in Botswana. Although a lower threshold requires a larger sample size and is therefore more expensive, it is much more likely to detect transmitted resistance and therefore would be more useful.

"If transmitted resistance is found to be at or above 3 percent, then repeating the WHO's test in the next scheduled occasion using a 5 percent threshold value would provide more information as to how quickly transmitted resistance is increasing in Botswana," Vardavas said. "Although this would be more expensive, it would probably be more cost-effective than the current strategy."

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The National Institute of Allergy and Infectious Diseases funded the study.

About the UCLA AIDS Institute

Established in 1992, the UCLA AIDS Institute is a multidisciplinary think tank drawing on the skills of top-flight researchers in the worldwide fight against HIV and AIDS, the first cases of which were reported in 1981 by UCLA physicians. Institute members include researchers in virology and immunology, genetics, cancer, neurology, ophthalmology, epidemiology, social science, public health, nursing, and disease prevention. Their findings have led to advances in treating HIV as well as other diseases, such as hepatitis B and C, influenza, and cancer.

Contact: Enrique Rivero
University of California - Los Angeles

Washington, D.C., Free Clinic To Close, Staff To Join Whitman-Walker Clinic

The Washington, D.C.-based Washington Free Clinic, which has provided low-cost or no-cost health care services since 1968 to people in the city, is scheduled to close on Friday, and its staff will be joining the Whitman-Walker Clinic, the largest provider of HIV/AIDS services in the region, the Washington Post reports. The Free Clinic serves about 1,800 patients, many of whom are working poor people and immigrants from Central America or Africa without health insurance. The clinic has a staff of about 50 volunteer doctors and nurses. Whitman-Walker -- which was launched by the Washington Free Clinic in 1973 as the Gay Men's VD Clinic and five years later became a separate organization -- is expanding its medical services in the district. Whitman-Walker has 7,000 clients, facilities in the district and Northern Virginia, and a $22 million budget. According to the Post, the alliance between the two clinics also will benefit Whitman-Walker after it experienced financial problems in 2005 that forced its leaders to "reconsider its long-term future," the Post reports. Gardiner Lapham, chair of the Free Clinic board, said, "It does come full circle. [Whitman-Walker is] now taking care of us," adding that closing is "really painful, but it's the right thing for the community." Free Clinic officials said they expect to be treating both Whitman-Walker and former Free Clinic clients by Jan. 29 (Levine, Washington Post, 1/14).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Billions Of Dollars Saved In U.S. By Polio Vaccination

A new study by researchers at the Harvard School of Public Health (HSPH) finds that polio vaccination in the United States has resulted in a net savings of over $180 billion, even without including the large, intangible benefits associated with avoided fear and suffering. This first study to retrospectively demonstrate the enormous benefits of polio vaccination appears as part of a special issue on polio in the December 2006 issue of Risk Analysis.

The history of polio vaccination in the U.S. spans over 50 years and includes different phases of the disease, multiple vaccines, and a sustained significant commitment of financial resources. Lead author of the study, Kimberly Thompson, associate professor of risk analysis and decision science at HSPH, emphasized that this study "should help people understand and better appreciate the huge economic savings that can come from investments in public health interventions."

The researchers, Professor Thompson and Dr. Radboud Duintjer Tebbens, a research associate at HSPH, estimated the costs and the effectiveness of historical polio vaccination strategies. They found that the U.S. invested over $35 billion between 1955 and 2005 and will continue to invest billions into the future to pay for polio vaccination. They estimated that these historical and future investments translate into over 1.7 billion vaccinations that prevent approximately 1.1 million cases of paralytic polio and over 160,000 deaths, thus saving Americans hundreds of billions of dollars in treatment costs.

Dr. Stephen Cochi, U.S. Centers for Disease Control and Prevention Global Immunization Division Senior Advisor and an expert on polio said, "This study documents the extraordinary power of vaccines not only as highly effective tools to prevent disease, disability, and death, but to provide enormous economic savings to society."

Although the last case of paralytic polio from wild poliovirus occurred in the U.S. in 1979, poliovirus outbreaks currently still occur around the world and American children continue to receive polio vaccinations. Dr. Bruce Aylward, Director of the Global Polio Eradication Initiative at the World Health Organization, stated that, "as we stand on the brink of eliminating wild polioviruses around the world, these results provide a glimpse of the massive economic benefits of global polio eradication." To date, the Global Polio Eradication Initiative has succeeded in reducing the annual cases of paralytic polio from an estimated 350,000 cases in 1988 to less than 2,000 cases in 2006. The only remaining areas of the world that have not yet disrupted transmission include regions in four countries (Afghanistan, India, Nigeria, and Pakistan). Thompson and Duintjer Tebbens also co-authored several other articles in the same issue that characterize the risks and costs of future options for polio risk management, the costs and value of global surveillance, and the trade-offs associated with different choices related to outbreak response.

Support for this study was provided by the Harvard Kids Risk Project. http://www.kidsrisk.harvard.edu/. Support for other studies by the authors in the special issue was provided by the U.S. Centers for Disease Control and Prevention.

Harvard School of Public Health is dedicated to advancing the public's health through learning, discovery, and communication. More than 300 faculty members are engaged in teaching and training the 900-plus student body in a broad spectrum of disciplines crucial to the health and well being of individuals and populations around the world. Programs and projects range from the molecular biology of AIDS vaccines to the epidemiology of cancer; from risk analysis to violence prevention; from maternal and children's health to quality of care measurement; from health care management to international health and human rights. For more information on the school visit: http://www.hsph.harvard.edu/.

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Tuberculosis Experts Outline Proposals To Speed Up Drug Development

Proposals to accelerate the development of tuberculosis (TB) drugs were outlined today at the conclusion of a two-day symposium titled "No Time to Wait," convened in New York this week by the international medical humanitarian organization Doctors Without Borders/MГ©decins Sans Frontires (MSF) with the support of Howard P. Milstein and Weill Cornell Medical College's Abby and Howard P. Milstein Program in Chemical Biology. The symposium brought together more than 100 TB specialists, drug developers and regulators, policy makers, donors and activists to outline practical proposals to fill the gaps in TB drug research and development (R&D).

"We are failing people with TB," said Dr. Tido von Schoen-Angerer, Director of MSF's Campaign for Access to Essential Medicines. "Diagnosing and treating TB is one of the greatest challenges facing health care providers around the world. Things are going from bad to worse with multi-drug resistant TB and even extensively drug resistant (XDR) TB, particularly in settings with high HIV prevalence. The urgency for new tools could not be greater - there is no time to wait."

TB kills nearly two million people per year, primarily because of inadequate diagnostic and treatment tools. While roughly one drug for HIV has been developed each year since the start of the epidemic 25 years ago, the latest novel TB drug in today's standard therapy was developed in the 1960s. Basic science is not being translated into new TB drugs needed to improve treatment, according to an MSF analysis of the TB drug pipeline. There are not enough promising drugs in the pipeline and serious funding gaps prevent the development of candidate drug compounds through to clinical trials.

Resistance to TB drugs is growing at a rapid pace, with 450,000 new cases of drug-resistant TB detected each year. The recent detection of hundreds of cases of XDR-TB, which is extremely difficult and sometimes impossible to treat, adds further urgency to the situation. TB remains the main killer of people with HIV, in large part because existing TB drugs and tests are poorly adapted for use in people with HIV/AIDS.

"In TB research, there needs to be a convergence of innovation, incentive, and access," said Dr. Carl Nathan, Rees Pritchett Professor of Microbiology and Chairman of Microbiology and Immunology at Weill Cornell Medical College. "We need to see openness, leadership and collaboration among all TB actors."

Experts attending the symposium emphasized several actions that urgently need to be taken to improve the situation:

1. Drastically increase funding of TB R&D
2. Accelerate drug discovery
3. Expand clinical trial capacity and speed up clinical development
4. Commit to global TB R&D leadership
5. Support new approaches to R&D, such as a global R&D framework

"We need increased clinical trial capacity, fast-tracked clinical trials, and criteria for compassionate use of important candidate drugs," said Dr. von Schoen-Angerer. "To make any real difference, we need to see a dramatic increase in funding and political will."

The symposium emphasized a need to build a global TB R&D movement, as was critical to the advancements in HIV drug development. Strong political leadership is required to improve collaboration between scientists, drug developers, care providers, and affected individuals. Symposium participants agreed on the need for a massive increase in funding by governments for TB R&D, as current TB drug discovery initiatives are insufficient. Participants voiced support for an effort launched by governments at the World Health Assembly in May 2006 to examine alternative ways to prioritize and finance health-needs-driven R&D.

http://www.doctorswithoutborders.org

Mozambican Red Cross To Train Hundreds Of Volunteers To Manage Antiretroviral Therapy For HIV-Positive People

The Mozambican Red Cross plans to begin training hundreds of volunteer health workers to manage antiretroviral therapy for HIV-positive people in their care, IRIN News reports. According to the Ministry of Health, the government, with the help of partner organizations, provides antiretroviral treatment to about 34,000 of the estimated 250,000 people living with HIV/AIDS who need treatment. Some nongovernmental organizations in the country have started antiretroviral management training for volunteers, but the NGOs have a limited reach, according to IRIN News. The Red Cross has a nationwide network of 600 volunteers in its home-based care program, which operates in nine of the country's 11 provinces. "This training is extremely important and will improve the work of" Red Cross volunteers, Paula Macava, coordinator of the Red Cross HIV/AIDS program in Mozambique, said, adding that the Red Cross has completed a training course on antiretroviral therapy management that is specifically designed for volunteers. The three-week training course, which is designed for volunteers with at last basic reading and writing skills, includes information on how to judge when an individual is ready to start antiretroviral therapy, and ensuring regimen adherence and good nutrition when taking antiretrovirals. The government aims to provide antiretroviral treatment to about 50,000 people living with HIV/AIDS by the end of 2007, according to the health ministry (IRIN News, 1/16).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Panelists Urge Businesses In Africa To Support HIV-Positive Employees, Women To Get Tested

Businesses in Africa should support HIV-positive employees, and more women on the continent should receive HIV tests and empower themselves with knowledge about HIV/AIDS, panelists at a Pan-African leadership summit in Cape Town, South Africa, said recently, allAfrica.com reports. The conference -- called "Vital Voices of Africa," and organized by the Washington, D.C.-based Vital Voices Global Partnership -- aims to develop an action plan to address HIV/AIDS in Africa. The conference also aims to address other issues, such as trade, economic development, good governance and violence against women. At the opening session of the conference, Joelle Tanguy, managing director of the Global Business Coalition on HIV/AIDS, Tuberculosis and Malaria, said that 90% of HIV-positive people in Africa are unaware of their status. Grietjie Strydom -- former director of Alexander Forbes Health Management Services in South Africa and a panelists at the conference -- said that HIV/AIDS is having a large impact on South Africa's economy. She added that it is financially more beneficial for companies to provide treatment for HIV-positive employees than to not provide treatment. "The private sector thinks that the government is helping" people living with the disease, but this often is not the case and companies should be encouraged to provide support for HIV-positive employees, she said. According to Strydom, HIV-positive people also need psychological therapy and mental and emotional support. According to Miriam Were, chair of the National AIDS Control Council in Kenya and panelist at the conference, there are more women than men living with and affected by HIV/AIDS. She suggested that a fund be created to provide money and support to women living with HIV/AIDS (Hendricks, allAfrica.com, 1/16).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Nigeria Plans To Pass Law Allowing Local Companies To Produce HIV/AIDS, Malaria Drugs

Nigeria is close to passing a law that would allow local pharmaceutical companies to manufacture more drugs to treat HIV/AIDS and malaria, Ahmed Abdulkadir, special adviser to the Nigerian president, said this week, Reuters South Africa reports. There are 14 companies that make antiretroviral drugs and eight companies that make artemisinin-based combination therapies in Nigeria, but they are not producing enough drugs to combat the diseases, according to Reuters South Africa. The country needs 109 million doses of ACTs annually to treat malaria, but local companies only meet 30% of the demand, and the rest is covered by treatments imported from China, Reuters South Africa reports. The new law aims to remove barriers to rapid production of the drugs, Abdulkadir said. He added that the legislation process is in the final stages and that the law will be sent to the National Assembly. Abdulkadir also said that Nigerian companies are preparing to boost drug production once the law is passed. "We are trying to get more machinery to produce more," he said, adding, "We don't want to be an importing nation. We want to be producing en masse and also supplying West and Central Africa." In addition, a program to grow Artemisia annua, the plant from which ACTs are derived, in Nigeria is being developed, according to Abdulkadir. Experts from China, where the plant primarily is grown, are advising Nigeria on how to cultivate the plant (Ee Lyn, Reuters South Africa, 1/17).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Scientists Perform 'Tricky' Operation

Trichomonas vaginalis colonises the urogenital tract and causes the infection also known as "trick", the most common non-viral STI.

University of Queensland PhD scholar Rebecca Dunne was one of a team of 65 scientists that worked on the project to sequence the genome, which could offer clues to better treatments for both men and women.

Ms Dunne said the results would allow researchers to hone in on genes and gene families of interest, particularly those involved in drug resistance.

"The completion of the genome sequence by The Institute for Genomic Research (TIGR) and subsequent annotation of the genome database has opened many avenues of research by providing a searchable data set," Ms Dunne said.

"Drug resistance in many human pathogens is increasing. T. vaginalis is among these, with no alternative drugs approved to treat resistant infections.

"This is particularly an issue in developing countries, where the number of infected individuals is high and the access to public health services is low.

"Now that researchers have access to a complete genome dataset the search for alternative drug targets can really take-off."

Amazingly, the pesky parasite was found to have an exceptionally large collection of DNA, with the possibility of having more genes than humans.

But Ms Dunne said while the sequencing of the genome project has largely elevated awareness of T. vaginalis among researchers, public awareness remains low, especially in developing countries where it has the most impact.

"This is a problem as infection with T. vaginalis increases the transmission and acquisition of many other serious STIs, including HIV.

"Furthermore, prolonged infection with T. vaginalis associates with pre-term birth, low infant birth weight and some cervical cancers.

"Alarmingly, trichomoniasis is not considered a notifiable disease."

Routine gynaecological check-ups do not test for this particular STI and the infection does not require public health notification.

Because of this, and also due to the broad and non-specific nature of symptoms, which can range from severe to negligible depending on the individual, some people pass it on without knowing.

"Furthermore, the non-specific nature (or in some cases, absence) of trichomoniasis symptoms often confuses it with other STIs, making the process of diagnosis itself, difficult," Ms Dunne said.

"Many infections remain undiagnosed as a result."

It is hoped that the results of the project will help research and improve treatments, in turn sponsoring awareness.

Ms Dunne's contribution to the project involved the identification and annotation of several large families of genes related to those involved in various mechanisms of antimicrobial resistance.

As a result of the genome being sequenced, she has since been able to localise specific genes of interest to the whole chromosome and begin the mapping process.

"Mapping the genome is the next step in the genome sequencing of T. vaginalis and will create a visual blueprint of the parasite, allowing researchers to see where their genes fit in to the big picture."

The results of the collaborative project have been published in the prestigious international journal

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Contact: Lucy Manderson
Research Australia

E.U. Resolution Calls On Libya To Release Medical Workers Sentenced To Death In Libyan HIV Infection Case

The European Parliament on Thursday in a resolution called on European Union member states to review their trade relations with Libya and to urge Libya to release six medical workers sentenced to death for allegedly intentionally infecting hundreds of Libyan children with HIV, Reuters South Africa reports. The resolution called on E.U. members to review "the common policy of engagement with Libya in all relevant fields." Bulgarian E.P. member Philip Dimitrov said the resolution sends a "clear signal of intent to Libya from the E.U. and with the support of the member states and the European Commission, it will show the E.U.'s solidarity on the matter" (Ennis, Reuters South Africa, 1/18). The five Bulgarian nurses and Palestinian doctor in May 2004 were sentenced to death by firing squad for allegedly infecting 426 children through contaminated blood products at Al Fateh Children's Hospital in Benghazi, Libya. They also were ordered to pay a total of $1 million to the families of the HIV-positive children. The Libyan Supreme Court in December 2005 overturned the medical workers' convictions and ordered a retrial in a lower court. A court in Tripoli, Libya, last month convicted the health workers and sentenced them to death. The health workers say they are innocent of the charges, claiming that they were forced to confess and that they were tortured by Libyan officials during interrogations (Kaiser Daily HIV/AIDS Report, 1/11). According to Reuters South Africa, the case has negatively affected Libyan leader Muammar Gaddafi's efforts to renew the country's ties with Western nations. In addition, some reports have said Gaddafi would release the medical workers if a Libyan who is in a Scottish jail for the 1988 Lockerbie bombing were released and if Libya received financial compensation for the alleged intentional HIV infections. Meglena Kuneva, E.U. consumer affairs commissioner, said there would not be a negotiation (Reuters South Africa, 1/18). "This has nothing to do with the Lockerbie case," Kuneva said, adding, "There isn't the slightest proof that these people are guilty, and the E.U. will not allow any other case to be used as a leverage." Bulgarian Foreign Minister Ivailo Kalfin last week said the medical workers likely will be in jail for one more year during an appeals process, adding that Bulgaria will increase international pressure if an appeal is unsuccessful. The E.U. on Thursday is expected to vote on the resolution (Ennis, Reuters Health, 1/17). In addition, Italian Prime Minister Romano Prodi on Wednesday said that he plans to urge Gaddafi to release the nurses at a Jan. 27 meeting of the African Union (Reuters, 1/17).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Change In Sexual Behaviors Needed To Curb Spread Of HIV In Africa, Some Health Experts Say

An increasing number of health experts believe that there is a need to change sexual behaviors, including a reduction in the number of sexual partners, to reduce the spread of HIV in Southern Africa, the Financial Times reports. Although a large amount of funding is directed toward HIV prevention programs, "far less effort has gone into persuading people to change their" sexual behaviors, according to the Times. "Prevention has concentrated on testing, condoms, safe blood and mother-to-child transmission -- things that fall easily off bureaucrats' lips," Derek von Wissell -- head of Nercha, Swaziland's official National Emergency Response Council on HIV/AIDS -- said, adding, "Behavior change is the difficult side. It needs a whole societal shift." Recent efforts in Swaziland and other African countries "reflect a new determination to tackle" behavior change -- a "sensitive subject" that has "long been politicized," the Times reports. In the U.S. and other countries, the debate surrounding HIV prevention has become "polarized" around which element of the ABC prevention method -- which stands for abstinence, be faithful and use condoms -- "should receive priority," according to the Times. "There was an immediate polarization between those saying condoms were evil and those who argued that only condoms were good," Daniel Halperin of the Harvard School of Public Health said. Halperin and some other public health experts have said that while all three elements of the ABC method are important, changing sexual behavior and partner reduction efforts have been the "neglected middle child" in ABC. Although condom use has been central to reducing the spread of HIV in countries like Brazil, Cambodia and Thailand, Ambassador Mark Dybul -- who serves as the U.S. global AIDS coordinator and administers the President's Emergency Plan for AIDS Relief -- said that a decrease in the number of men visiting commercial sex workers also contributed to the reduction in HIV cases. "Applying lessons (of condom use) from a concentrated epidemic to a region where there is a generalized epidemic was bordering on scientific insanity," Dybul said, adding, "We have not listened enough to Africans. It is tough to find one who doesn't say, 'A, B and C is what we need.'"

Movement Toward Behavior Change?
Although there is "no single or satisfactory explanation" for why HIV prevalence is higher in Southern Africa than the rest of the world, a "growing body of evidence points to the predominant role of one aspect of sexual behavior" -- that men and women often have "concurrent sexual partners over months or years," the Times reports. This practice contributes to the spread of HIV because the virus' ability to be transmitted peaks during the weeks after a person becomes infected, meaning that an HIV-positive person with multiple partners can spread the virus quickly to others, according to the Times. In addition, long-term sexual partners are less likely to use condoms -- increasing the likelihood that if one partner is HIV-positive, the virus will be transmitted to the other. The effect of such behaviors on the spread of HIV is beginning to be acknowledged, according to the Times. A report presented last year at a conference convened by the Southern African Development Community examined instances in which the number of HIV cases appeared to be decreasing and linked these reductions to successful behavior change programs in countries such as Kenya, Uganda and Zimbabwe (Jack, Financial Times, 1/18).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Time To Revise Policy On Self-Testing For HIV

A review of government policy about self-testing for HIV is needed in the UK in order to increase the uptake of HIV testing, according to a Viewpoint in the Lancet.

An estimated 31% of people in the UK are unaware of their HIV-positive status. But early diagnosis is important to manage the illness effectively, and so that people who are HIV positive can reduce the risk of transmitting the virus to others. Since 1992 it has been illegal to sell or provide any self-test for HIV to any member of the public in the UK.

Lucy Frith (Division of Primary Care, University of Liverpool, UK) challenges the case against self-testing for HIV in light of new technologies that enable rapid and accurate HIV testing, advances in antiretroviral therapy, and the increasing emphasis on patient autonomy. She notes that the trend in health care towards an emphasis on patient autonomy has led to greater self-diagnosis and screening. People have been encouraged to take responsibility for their own health and to make informed decisions without direct intervention from health-care professionals. She argues that if self-testing for HIV is not harmful, there should be no grounds for keeping it in a clinical setting. She discusses the most common arguments against self-testing-the absence of counselling before and after the test, the accuracy of self-tests, the ability of people to provide adequate samples and interpret the test correctly, and the possibility of abuse or testing someone without their consent-and recent changes in practice and advances in technology that undermine these arguments.

The author concludes: "If practitioners truly believe in patient autonomy, people should be allowed to choose where, when, and how they are tested for HIV, where the technology exists. When appropriate self-test kits become available, the UK needs to be in a position to benefit from their use."

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Contact: Lancet press office
Lancet

Chinese Province Requires People To Provide Real Names, Contact Information When Taking HIV Tests

China's Yunnan province has begun requiring people to provide their real names and contact information when taking HIV tests, Xinhua/People's Daily reports. According to Lu Lin, director of the Disease Prevention and Control Center of Yunnan, more than 150,000 people volunteered to take HIV tests in the province in 2006, an increase of 30,000 from the previous year. Providing real names and contact information will help medical workers provide follow-up treatment if people test HIV-positive, Lu said, adding that the requirement will enable HIV-positive people to "receive free medical treatment as soon as possible." Lu also pledged to protect the privacy of those who are tested, saying that medical workers will be prosecuted if they reveal HIV-positive people's personal information. Many people who take HIV tests give false personal information because of concerns related to stigma and discrimination, which means they miss the "best time for treatment," Lu said. Yunnan has 210 labs to screen and diagnose HIV/AIDS, and the number of labs might increase in the future, according to Lu (Xinhua/People's Daily, 1/18). According to official statistics, the number of HIV-positive people in Yunnan increased from 14,905 in 2003 to 40,157 by the end of 2005 (Kaiser Daily HIV/AIDS Report, 12/5/06). By the end of September 2006, the number increased to 47,314 (Xinhua/People's Daily, 1/18). The number of HIV cases in the province now accounts for one-quarter of the national HIV caseload. In addition, the Provincial Committee of AIDS Prevention and Control says HIV/AIDS cases have been detected in 128 of the province's 129 counties (Kaiser Daily HIV/AIDS Report, 12/5/06).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Australian State Unveils Strategy To Reduce By 25% New HIV Cases By 2009 With Focus On MSM

The Australian state of New South Wales this week unveiled a new three-year HIV/AIDS strategy that aims to decrease new recorded HIV cases by 25% and that focuses on men who have sex with men, the Sydney Star Observer reports. The strategy includes increasing education about how drug use can lead to risky sexual behavior, as well as improving health services for MSM in regional areas. The plan was announced as New South Wales data indicate that the number of recorded new HIV cases was reaching its lowest levels in years. According to Geoff Honnor, executive officer of People Living With HIV/AIDS-New South Wales, the 340 projected number of HIV notifications for 2006 represents a 14% decrease since 2005. The lowest number of notifications was 339 in 2001, according to Honnor. AIDS Council of New South Wales CEO Stevie Clayton attributed the projected decrease to more consistent condom use and strong collaboration among the state's health organizations. Although Clayton expressed confidence that the new strategy could decrease the number even more, she added that HIV prevention would be an ongoing challenge. While it is a "really good thing to see data produced that's showing there's a reduction in HIV transmissions, we need to stay really vigilant about it and not think that means everyone can breathe a big sigh of relief and not have to worry about safe sex anymore," Clayton said, adding, "It's really important, in the context of a decrease in the rate of transmissions, to reinforce the need for safe sex" (Gould, Sydney Star Observer, 1/18).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Drug Treatment Seekers More Likely To Use Needle Exchange

A new study by researchers at the Johns Hopkins Bloomberg School of Public Health examined the connection between Baltimore City's needle exchange program and drug treatment programs. Individuals who enter treatment programs for drug addiction were more likely to be HIV-positive females who use the Baltimore City needle exchange programs. The study highlights the need for treatment facilities to address co-occurring problems, such as HIV and mental illness. It is published in the December 2006 edition of the journal Substance Use & Misuse.

"Needle exchange programs and drug user treatment centers are two effective strategies to reduce HIV infections and drug abuse," explained Carl A. Latkin, PhD, lead author of the study and a professor in the Bloomberg School of Public Health's Department of Health, Behavior and Society. "Needle exchange programs reduce the number of contaminated syringes in a community and drug treatment reduces drug use, which may indirectly reduce HIV transmission."

In their analysis, the study authors included 440 injection drug users who were interviewed from 1997 to 2002 as part of the Self-Help in Eliminating Life-Threatening Diseases (SHIELD) study. At follow-up, 166 of the study participants were enrolled in methadone maintenance or detoxification, or a drug-free residential or outpatient treatment program. Individuals who entered treatment programs were more likely to be female, unemployed and participants in Baltimore City's needle exchange program, compared with individuals who did not enter drug treatment programs. Those in treatment were also more likely to be HIV positive, have a history of mental illness and inject heroin. Individuals who did not enter treatment programs were more likely to sniff or snort cocaine or heroin.

"Needle exchange programs are an important part in linking drug users with treatment. Creating trusting relationships with health care providers may encourage more injection drug users to enter drug treatment programs. Our study results clearly point to the need for strong linkages between needle exchange programs and treatment programs. There is also a need for treatment services that have the capacity to address co-occurring health problems found among drug users in Baltimore City," said Latkin.

The study authors also point out the need to publicize the services offered by needle exchange programs beyond needle distribution and disposal.

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Authors of the study, from Johns Hopkins, include Carl A. Latkin, Melissa A. Davey and Wei Hua.

Funding for the study was provided by the National Institute on Drug Abuse.

Contact: Kenna L. Lowe
Johns Hopkins University Bloomberg School of Public Health

Studies Examine Effect Of Male Circumcision On Sexual Behavior, Breast-Feeding Interventions For HIV-Positive Women

The following highlights recently released journal articles on HIV/AIDS.

Male Circumcision in Siaya and Bondo Districts, Kenya: Prospective Cohort Study To Assess Behavioral Disinhibition Following Circumcision," Journal of Acquired Immune Deficiency Syndromes: Kawango Agot -- project coordinator of a collaborative research project among the University of Nairobi, University of Illinois and the University of Manitoba -- and colleagues conducted the study among 324 recently circumcised men and 324 uncircumcised men to determine the effect of circumcision on sexual behavior. The researchers compared the two groups' sexual behaviors at one, three, six, nine and 12 months following circumcision or study enrollment. They found that during the first month following circumcision, men were 63% less likely to report having 0 to 0.5 risky sexual acts weekly than uncircumcised men. The researchers also found that during the first month following circumcision, men were 61% less likely to report having more than 0.5 risky sexual acts weekly than uncircumcised men. The differences in sexual behavior disappeared during the remainder of the follow-up period, and similar results were seen for risky unprotected sexual acts, number of at-risk sexual partners and condom use, according to the researchers. The researchers concluded that during the first year following circumcision, men did not report an increased number of risky sexual acts compared with uncircumcised men -- indicating that "any protective effect of male circumcision on HIV acquisition is unlikely to be offset by an adverse behavioral impact" (Kawango et al., Journal of Acquired Immune Deficiency Syndromes, 1/1).

Two-Year Morbidity-Mortality and Alternatives to Prolonged Breast-Feeding Among Children Born to HIV-Infected Mothers in Cote d'Ivoire," PLoS Medicine: Renaud Becquet of the Institut National de la Sante et de la Recherche Medicale Unite in France and colleagues conducted the study from 2001 through 2005 among 557 infants born to HIV-positive women in Abidjan, Cote d'Ivoire. After their infants were born, the women, who underwent prenatal antiretroviral prophylaxis, either received breastmilk substitutes or exclusively breast-fed for four months. Nutritional counseling and clinical management were provided for two years, and breastmilk substitutes were provided at no cost. Thirty-four percent of the 262 infants who were breast-fed for an average of four months during the two-year follow-up period did not experience any adverse health outcomes -- which the researchers defined as diarrhea, acute respiratory infections or malnutrition -- compared with 37% of the infants who received breastmilk substitutes. The two-year probability of presenting with a severe health event -- which the researchers defined as hospitalization or death -- was 14% among the breastmilk substitute group, compared with 15% among the breast-fed infants. The researchers concluded that breastmilk substitutes and short-term breast-feeding can be safe interventions aimed at preventing mother-to-child HIV transmission in urban African settings where adequate nutritional counseling and care, access to clean water and breastmilk substitutes are available (Becquet et al., PLoS Medicine, January 2007). In a related opinion piece, Grace John-Stewart of the University of Washington writes that the researchers "provide good data to suggest that with appropriate provisos, replacement feeding can be a safe option to consider" for HIV-positive women in urban African settings (John-Stewart, PLoS Medicine, January 2007).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.